The Pulse | Society | South Asia

A Hospital in Nepal Errs and a Baby Boy Faces Death

Medical negligence continues to be a problem in Nepal.

By Arun Budhathoki for
A Hospital in Nepal Errs and a Baby Boy Faces Death
Credit: CC0 image via Pixabay

KATHMANDU – Rihan Neupane was born to Ekata Ghimire and Sanjeev Neupane on June 26, 2018, in Nepal’s Grande International Hospital. Rihan was born at 36 weeks and a day, weighing 2.85 kilograms (by way of a Cesarean delivery). But right after his birth, according to his parents, he suffered from breathing problems.

Rihan was diagnosed with pneumonia and was kept at the Intensive Care Unit (ICU). With no signs of improvement, he was then moved to a mechanical ventilator.

Unfortunately, Rihan caught a Klebsiella bacterial infection from the ventilator. Rihan was given antibiotics for 14 days and kept in the ICU. The parents returned home without their baby, hoping the doctors and nurses would treat the baby well, visiting him during hospital hours.

Rihan was discharged after 21 days but on the third day out of the hospital he came down with a fever, and as per the doctors’ suggestion, the parents took the boy to the same hospital for a 24-hour observation. The stay that day would extend to 42 days as Rihan was then diagnosed with meningitis.

There was delay in performing a CT/MRI scan, as mentioned in the medical council’s findings.

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An ultrasound scan showed an abscess in his brain and doctors suggested a brain operation. Five days later another operation was performed to install a pipe in the baby’s brain to drain the clogged pus. Rihan’s father, Sanjeev, had lost his father a month later after Rihan’s birth.

The doctors at Grande performed surgery a third and fourth time for ventriculoperitoneal (VP) shunting. After the fourth surgery, Rihan had been in the hospital for 67 days; his parents were told that the baby could go home on October 9, 2018. Soon an ultrasound showed hydrocephalus and an 8.2 cm long and 1 cm wide build-up of cerebrospinal fluid in the brain.

Dr. Amit Thapa, who was a part of the surgery team, disagreed with the radiologist’s report and said that the build-up should be 8 mm long and not 8 cm. Dr. Thapa assured Rihan’s parents that nothing was wrong. Meanwhile, Rihan’s head started to grow bigger and the fifth surgery was done to drain the fluid. After the surgery, it appeared that the radiologist was right and Dr. Thapa was wrong about the size of the fluid in the brain. It was known later that the hospital was also planning to perform a sixth surgery.

Soon tensions escalated between the doctors and the parents. A nurse was seen trying to give Rihan a 66 ml dose of paracetamol; the parents told the nurse to recheck and the nurse said it was a mistake. But the boy was given 66 ml dose eventually at the ICU.

Dr. Chakra Raj Pandey, an orthopedic surgeon, and director of Grande Hospital accepted the fact that the boy was given an overdose of the paracetamol and the hospital would do everything to save the child. Another infection was seen in Rihan’s urine, resulting in a fever. The parents spent several nights applying a wet cloth on the baby’s forehead and no nurses came to visit them.

The parents agreed to continue treating their child at the Grande hospital but lodged a complaint at the Nepal Medical Council for the hospital and doctors’ negligence and medical malpractices.

An investigation found errors with the hospital’s administration, including medical errors, and assured that action would be taken against those involved. The hospital’s director, Dr. Pandey, refused to acknowledge any mistake on his hospital’s part.

Dr. Pandey said that the child had suffered from neonatal pneumonia but it got worse as the doctors were treating him. Pandey said Klebsiella bacteria infection was common in hospitals and they shouldn’t be blamed for it. Pandey refuted any miscommunication between the radiologist and the doctor; he agreed that the paracetamol dose was a mistake but said it did no harm to the child.

Rihan’s parents’ disappointment and sadness has led them to consider taking the hospital to the court, but Sanjeev is hesitant to do so despite them spending hefty money on their child. They have no hope that the boy will survive and have started donating the child’s toys.

Sanjeev says, “We are not blaming the doctors, nor the hospital team but suggesting them to be human and take care of patient as human [and] not as a case, because the patient may be a case for them, but is life for the victim. Doctors and nurses are also humans, they are not gods. There are human errors in each and every profession but accepting those errors and being accountable for those errors performed is the key to success to any profession.”

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He further added, “We are not saying that doctors should be able to treat every patient and make them healthy again and give them their life back. Our story is different; a series of mistakes [which could have been eliminated] has made our life a real struggle and a curse for us. Our only concern is that, they should be accountable for whatever they are doing.” Sanjeev wants answers to numerous questions regarding how Rihan was answered.

In the Grande Medical Journal published by the same hospital on December 9, 2018, the doctors illustrated a detailed event of the baby boy’s health issues and concluded that their treatment had been a success, contrary to the child’s present state, raising a question mark on the medical teams’ competency and findings.

A majority of private hospitals have the reputation of medical malpractices, forcing parents to go for a Cesarean operation than a normal delivery, charging excessive fees, providing expired medicines, hiring incompetent doctors and nurses, et cetera. A 2014 report revealed how private hospitals in Nepal practiced an unethical business when it came to Cesarean surgeries.

Nepal Medical Council (NMC) has refrained from punishing the hospital severely and only ordered to put a pediatrician doctor, Dr. Dipika Dhakal, on probation and merely issued a warning to another doctor, Amit Thapa citing breach of Code of Ethics and Professional Conducts 2017. On the other hand, Grande hospital remains defiant and refuses any wrongdoings in their part.

The findings of NMC concluded that the hospital management went against doctors’ advice to not keep the baby in ICU, also citing other medical negligence. The medical council also told the parents that they do not have the power to provide compensation and they should go to the court if they want to sue the hospital.

Nepali hospitals, particularly management, suffer from increasingly negligence, profit-seeking policies, and high costs – where patients are on the receiving end, with no state intervention, and no proper healthcare system.

News of hospital deaths and medical negligence in Nepal continue.

Arun Budhathoki is a Nepal-based journalist.